Support for infant and young child feeding and care in emergencies: experiences from Australia and eleven other high-income countries.

Introduction: In 2010, the World Health Assembly urged all member states, including those of high income, to implement disaster plans in line with the Operational Guidance for Infant and Young Child Feeding in Emergencies (OG-IFE). However, analyses of infant and young child feeding in emergencies (IYCF-E) planning across Europe, the United States of America (USA) and Australia have indicated a lack of such planning. This study aimed to identify challenges, lessons and solutions in infant and young child feeding and care in disasters in high-income countries to inform improved emergency planning in Australia and other high-resource settings. Method: Semi-structured interviews were conducted with 39 emergency responders from Australia and 20 emergency responders from Canada, Croatia, Iceland, Ireland, Italy, Japan, New Zealand, Poland, the United Kingdom, Ukraine, and the USA. Data was collected on the challenges of providing emergency response to infants and young children and their caregivers, as well as successful interventions and facilitators of intervention uptake. Interviews were recorded, transcribed and then analysed using reflexive thematic analysis. Through the analysis process, the OG-IFE and the World Health Organization's nurturing care in emergencies brief assisted understanding regarding challenges, gaps and response appropriateness. Results: Challenges to support infants and young children in emergencies were consistent between countries and involved lack of prioritisation, planning, and data collection regarding infants and young children; lack of planning, knowledge and appropriate support for IYCF-E; and the donation of infant formula. Interventions to support mothers and caregivers of infants and young children were more variable between countries and included making support needs and gaps visible, providing tailored evacuation centre support, implementation of IYCF-E interventions, and supporting responsive caregiving. Intervention uptake was facilitated via training staff and volunteers, support of community members, involvement of government agencies and UNICEF, and collaboration between health agencies and emergency organisations. Family resilience was promoted at individual and community levels. Conclusion: Infants and young children are vulnerable in emergencies globally. This research has identified challenges and a range of strategies to strengthen disaster planning in high-income countries, including the appropriate development and implementation of IYCF-E plans aligned with the OG-IFE.